Recovering at the Hospital

After surgery, you will wake up in the PACU (Post Anesthesia Care Unit) or sometimes in the surgical ICU (Intensive Care Unit). The PACU is often referred to as the “recovery room.”

You may have a facemask on that delivers oxygen, intravenous lines in your neck or arms, chest drains and a bladder-drainage catheter. You will also have inflatable boots on your legs that help your circulation after surgery. The PACU is a busy area with bright lights and a lot of monitoring equipment. You may feel disoriented as you wake up from surgery. On average, patients remain in the PACU for 90 minutes. You will then be transferred to the appropriate nursing unit.

On rare occasions, patients will need to remain on a breathing machine (ventilator) after surgery and will be transferred to the surgical ICU. These patients may wake up with a breathing tube still in place. The breathing tube will not allow you to talk, but you should still be able to respond to questions. The nurses and your surgical team will be able to assess and anticipate most of your needs at that time. As soon as you are awake and able to breathe on your own, the breathing tube will be removed.

Patients being transferred to the surgical floor will generally go to 7SW. The nursing station on this floor can be reached directly at (206) 386-6207.

The nurses will measure your temperature, blood pressure, pulse and breathing (vital signs) on a regular basis. They will also check your oxygen saturation and make sure that you are recovering from your operation. They will record drainage from your chest tubes and bladder catheter and keep track of the fluid you take in.

Each morning members of the thoracic-surgery team will visit you in your room to examine you and review your progress over the last 24 hours. We will talk with you and your family and outline our plan of care for the day. Your nurses will also be able to explain all procedures and plans with you. Please feel free to ask questions at any time.

Oxygen, Coughing and Deep Breathing

You will be given oxygen after surgery until it is no longer needed. Oxygen is delivered in different ways. You may wear an oxygen mask or oxygen tubing that fits just inside your nose. Please let the nurses know immediately if you have difficulty breathing or feel any shortness of breath.

You will be instructed on how to use a breathing device called an “Incentive Spirometer.” This device has a mouthpiece that you use like a straw. You need to inhale ten big breaths six times every hour to help open up your lungs after surgery.

Some patients will also use a second device called an “Acapella.” You blow through the Acapella device. This helps loosen up secretions so that you can cough them out. These are both useful devices when you go home from the hospital. You can practice your breathing exercises with each commercial on TV.

Coughing is a necessary part of the breathing exercises. Because coughing may be associated with pain after surgery, the nurses will show you how to hold a pillow over your incision to act as a “splint.” Splinting with a pillow makes coughing easier and less painful. The nurses and respiratory therapists will help coach you through your breathing exercises.

Pain Control

Pain control is very important for a successful recovery. We will do everything we can to minimize your pain. While we cannot eliminate all pain, we want to make you as comfortable as possible. Our pain-control goal is to allow you to cough, deep breathe and move around more easily after surgery. We may use one or more methods to treat your pain.

If you have chronic pain or are taking pain medication at the time of your surgery, you are eligible for a pre-operative consult with the Swedish Pain Center. The thoracic- surgery team is working closely with the Swedish pain specialists to minimize your post-operative pain and optimize your medications to assist you in the recovery period after your operation. For more information about the Swedish Pain Center, visit their website at http://www.swedish.org/pain.

The surgical team will ask you about your pain on their daily visits. Please let the doctors and nurses know if you have any discomfort or if you are not getting relief from your pain medication. You will be asked to rate your pain on a scale from 1-10 to evaluate how well your pain medication is working. A score of zero means that you have no pain at all. A score of 10 means that you are having the worst pain you have ever had.

No Pain Moderate Pain Worst Pain

0 1 2 3 4 5 6 7 8 9 10

Epidural Catheter

Our surgeons may ask the anesthesiologist to place a small catheter in your back before your operation. Pain medication is delivered through the epidural catheter around your spinal cord to decrease your ability to feel pain around your surgical incision.

Pain Controlled Analgesia (PCA)

Some patients will have a pain medication pump attached to their IV line. You will have a button that delivers a small but effective amount of pain medication when you push it. However, you should push the button when you feel pain or before beginning physical activity. The system is designed so that you will only get a small amount of pain medication every few minutes. You do not need to worry about getting too much medication. Do not allow family or friends to push the button for you.

Pain Medication by Mouth (oral)

When you are able to eat, you will be switched to oral pain medication. We generally use “opiates” in both long-acting (timed released) and short-acting formulas. Most patients will be on opiates when they leave the hospital. We encourage you to take the medication as prescribed so that you are able to cough, deep breathe and walk throughout the day. The right dose of pain medication is the dose that works. Additionally, we may use muscle relaxants and anti-inflammatory medications to work with your pain medication.

Some patients are reluctant to take pain medication because they are concerned about becoming addicted to them. However, most patients are not on these medications long enough to worry about this. We will work with you to wean these medications over time.

The most common side effects of pain medications are constipation, nausea and sedation. You will be given stool softeners and laxatives as needed to prevent constipation. And we encourage you to take your pain medication with food to avoid nausea.

Wound Care

Your surgical dressings will be removed by the second day after surgery. Most surgical incisions are covered with steri-strips to keep the skin edges together. The underlying tissue layers are sutured with an absorbable material that will dissolve after several weeks.

You may shower when your surgical dressings and chest tubes have been removed. You can gently cleanse your incisions with soap, rinse well and pat them dry.

Surgical wounds generally heal in six weeks. The incisions heal more quickly if they are kept clean and dry. We do not recommend applying antibiotic ointments, lotions or creams to your surgical incisions as they tend to keep the skin moist. Moist skin breaks down more easily. Because of this, we ask that you avoid soaking in a tub until your skin has sealed and you have been given permission by your surgeon.

Dry dressings may be applied if an incision is draining. If you develop drainage at home that is cloudy or has an odor to it, please call our office immediately. Any sutures remaining in place when you leave the hospital will be removed at your first clinic appointment.

Numbness, tightness, and itching around your incision are normal. These sensations should disappear over time. Some numbness may be permanent.

Sequential Compression Stockings

These plastic inflatable sleeves are wrapped around your lower legs and inflate every few minutes to squeeze your calves. This helps your circulation while lying in bed and prevents the formation of blood clots. When you are walking regularly, these will no longer be needed.

Drains

Nasogatic (NG) tubes are used after esophageal surgery to keep the stomach empty and prevent nausea and vomiting. These are generally removed when your stomach starts to work again after the operation.

Chest tubes, also called drains, are placed in the operating room after surgery to remove air and fluid from the area between the lung and your chest wall. These are removed after a few days, in most cases. If there is a lot of drainage or air leaking from the chest tubes, they will remain in place for a longer period of time. You will have frequent chest X-rays to monitor your lungs after surgery.

On rare occasions, patients will be discharged from the hospital with one remaining chest tube still in place. These patients are seen weekly in the thoracic surgery clinic until the chest tube is removed.

Urinary Catheter

A catheter will be placed in your bladder during surgery to allow your bladder to empty since this is sometimes difficult immediately following an operation. This will be removed after a few days.

Medications

You will receive other medications while in the hospital. You will be on IV antibiotics to prevent an infection and you will receive small Heparin shots under your skin to prevent the formation of blood clots in your legs (known as deep vein thrombosis or thrombophlebitis). The Heparin shots will be stopped when you are walking regularly or when you leave the hospital. Patients who have lung surgery will have breathing treatments to help with coughing and clearing secretions.

Most, if not all, of your regular medications will be restarted as soon as possible after your surgery. When you leave the hospital, a new medication list and instructions will be provided to you.

Diet

Depending on the type of surgery you have, you may be able to drink and eat as soon as you are awake. Your diet will slowly be advanced as you tolerate regular food. Medications will be available for nausea and to prevent constipation.

Physical Therapy (PT) and Occupational Therapy (OT)

Your nurses will help you sit up on the edge of your bed after surgery. Next you will move to sit in a chair and soon you will start walking again after your operation.

Therapists may be asked to work with you to slowly increase your activity after surgery. PT will assist you with walking and stair climbing, while OT will work with your arms and help you with activities like eating, showering and getting dressed.

It is important to be active after surgery. When you leave the hospital you should walk every day. We recommend that you increase the distance you walk every day, but it is not important to increase your speed. Try to plan periods of activity followed by periods of rest at home. And when you are resting, elevate your legs to prevent swelling.

Shoulder range-of-motion exercises will prevent stiffness, especially on the side of your surgery. These should be done two to three times a day. You can also walk your fingers up the wall (on the operative side) to get a good stretch through your shoulder.

Most patients are restricted from lifting more than ten pounds for six weeks. After six weeks, you may increase any activity as tolerated. You may find that your muscles have become weakened during that time, so proceed slowly and let pain be your guide.

It is normal to feel fatigue while recovering from surgery. It is one of the ways your body responds to the stress of surgery. Fatigue is generally worse immediately after surgery and should improve over time. Strength and stamina are slow to return, but it is important to keep moving!

The Swedish Cancer Institute, in collaboration with Swedish Outpatient Rehabilitation Services, offers a wide range of cancer rehabilitation services for patients interested in exercise therapies to improve their well-being. For more information about the Cancer Rehabilitation Program at Swedish, call (206) 215-6333.